Irritable Bowel Syndrome and The Invisible Enemy

Valley of the Kings Egypt (Dr. Noorali Bharwani)
Valley of the Kings Egypt (Dr. Noorali Bharwani)

COVID-19 has caused significant stress and anxiety among the general population. Individuals with a history of irritable bowel syndrome (IBS) will have aggravation of symptoms.

IBS is a common medical condition that affects the large intestine. It is a chronic condition that requires long term management. Unfortunately, the pathology and physiology of IBS is not fully understood.

Usually, only a small number of people with IBS have severe symptoms. Some people can manage to control their symptoms by managing diet, make lifestyle changes and controlling stress.

More severe symptoms can be treated with medication and counseling. But management of IBS is not always easy. IBS is a relapsing and remitting disorder in which the predominant bowel habit and symptoms can change over time. It is like COVID-19 except IBS is usually not life threatening.

We don’t know what causes IBS. But we know stress aggravates the symptoms.

Good news is IBS does not cause changes in bowel tissue or increase your risk of colorectal cancer.

The most recent review on this subject was published in the Canadian Medical Association Journal (CMAJ March 16, 2020 – An approach to the care of patients with irritable bowel syndrome).

IBS is a disorder of gut – brain interaction leading to abdominal pain with a change in frequency or form of bowel habit. Forty per cent of patients referred to a gastroenterologist have IBS.

IBS affects four per cent of men and eight per cent of women in Canada, with a peak incidence in ages 18 – 34 years. It can occur in patients with other medically unexplained conditions, such as fibromyalgia and depression or anxiety. Symptoms typically vary in frequency and intensity, and are often aggravated by stress. It is very disruptive to an individual’s work schedule and life style.

When a person has symptoms suggestive of IBS, the burden falls on the physician to make sure other conditions like inflammatory bowel disease (IBD), celiac disease, bile acid diarrhea and carbohydrate malabsorption (e.g. lactose intolerance) are not missed.

Patients who need further investigations are those whose first presentation of symptoms are at age 50 or after, has weight loss, has rectal mass or bleeding, and has family history of colon and rectal cancer.

Diagnosis relies on the identification of chronic typical symptoms characterized by abdominal pain, bloating and change in frequency or form of bowel habit.

The clinical management of IBS can be challenging. The CMAJ article says physician should establish positive therapeutic relationship with patients, underpinned by patient education. That is key to optimizing clinical outcomes. You cannot cure the problem but managing the bothersome symptoms is the mainstay of IBS treatment.

While several management options exist, none of them are effective to cure the problem. They can provide some symptomatic relief. For more information visit: The IBS Network.

In conclusion, IBS is a common disorder characterized by chronic abdominal pain that is associated with a change in frequency or form of bowel habit. The underlying cause is incompletely understood. Therefor treatments are based on symptom management. That include education and reassurance, dietary modifications and pharmaceutical interventions, largely directed toward improving the most bothersome symptoms.

This brings us to the current situation of dealing with the invisible enemy (COVID-19) and the stress it is causing. This is having negative physical and mental effect on our body. Best thing is to do what the experts say and hope for the best.

Manage your stress by doing meditation, yoga, and establish network with friends and family. There are many options available online. Be creative. Be safe and take care.

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